Senate Bill 2541

AN ACT TO CREATE A HEALTH INSURANCE REVIEW PANEL TO BE ESTABLISHED BY THE COMMISSIONER OF INSURANCE; TO PROVIDE THAT UPON DENIAL OF A HEALTH INSURANCE CLAIM, THE INSURED MAY REQUEST FOR A REVIEW OF THE CLAIM; TO PROVIDE THAT THE PANEL SHALL HAVE THE SOLE DUTY TO EXPRESS ITS EXPERT OPINION AS TO WHETHER OR NOT THE EVIDENCE SUPPORTS THE CONCLUSION THAT THE CLAIM SHOULD HAVE BEEN DENIED; TO PROVIDE THAT ANY REPORT OF THE EXPERT OPINION REACHED BY THE HEALTH INSURANCE REVIEW PANEL SHALL BE ADMISSIBLE AS EVIDENCE IN ANY ACTION SUBSEQUENTLY BROUGHT BY THE CLAIMANT IN A COURT OF LAW; TO PROVIDE THAT EACH MEMBER OF THE HEALTH INSURANCE REVIEW PANEL SHALL BE PAID A PER DIEM; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. (1) All health insurance disputes, other than claims validly agreed for submission to a lawfully binding arbitration procedure, shall be reviewed by a health insurance review panel established by the Commissioner of Insurance.

(2) Upon denial of a health insurance claim, the insured may request for a review of the claim by the health insurance review panel. It shall be the duty of the board within fifteen (15) days of the receipt of the claim to:

(a) Confirm to the claimant that the filing has been officially received; and

(b) Notify the insurer that a filing has been made and forward a copy of the proposed complaint to the insured at his usual place of business.

(3) The evidence to be considered by the health insurance review panel shall be promptly submitted by the respective parties.

(4) The panel shall have the right and duty to request and procure all necessary information.

(5) The panel shall have the sole duty to express its expert opinion as to whether or not the evidence supports the conclusion that the claim should have been denied.

(6) Any report of the expert opinion reached by the health insurance review panel shall be admissible as evidence in any action subsequently brought by the claimant in a court of law, but such expert opinion shall not be conclusive and either party shall have the right to call, at his cost, any member of the health insurance review panel as a witness. If called, the witness shall be required to appear and testify. A panelist shall have absolute immunity from civil liability for all communications, findings, opinions and conclusions made in the course and scope of duties prescribed by this act.

(7) (a) Each member of the health insurance review panel shall be paid a per diem, as provided in Section 25-3-69, for all work performed as a member of the panel exclusive of time involved if called as a witness to testify in a court of law regarding the communications, findings and conclusions made in the course and scope of duties as a member of the health insurance review panel, and in addition thereto, as reasonable travel expenses as provided in Section 25-3-41.

(b) (i) The costs of the health insurance review panel shall be paid by the insurer if the opinion of the health insurance review panel is in favor of the insurer.

(ii) The claimant shall pay the costs of the health insurance review panel if the opinion of the health insurance review panel is in favor of said claimant. However, if the claimant is unable to pay, the claimant shall swear under oath to the health insurance review panel that said claimant cannot afford the costs of the health insurance review panel as they accrue, then the costs of the health insurance review panel shall be paid by the insurer, with the proviso that if the claimant subsequently receives a settlement or receives a judgment, the advance payment of the health insurance review panel costs will be offset.

(c) If the health insurance review panel decides that there is a material issue of fact bearing on liability for consideration by the court, the claimant and the insurer shall split the costs of the health insurance review panel. However, in those instances in which the claimant is unable to pay his share of the costs of the health insurance review panel, the claimant shall swear under oath by the health insurance review panel that said claimant cannot pay his share of the costs of the health insurance review panel as they accrue. The claimant's share of the costs of the health insurance review panel shall then be paid by the insurer with the proviso that if the claimant subsequently receives a settlement or receives a judgment, the advance payment of the claimant's share of the costs of the health insurance review panel will be offset.

(8) The chairman shall submit a copy of the panel's report to the board and all parties by registered or certified mail within five (5) days after the panel renders its opinion.

(9) The Commissioner of Insurance may adopt any rules and regulations necessary to carry out the provisions of this act.

SECTION 2. This act shall take effect and be in force from and after July 1, 2004.